spinal axis. Nothing noteworthy was seen during the removal of the brain and cord save the deep and widespread involvement of the tissue about the bedsore. The naked eye appearance of the brain and cord was not abnormal. The principal stains used were the Marchi, Nissl, Van Giesen, and Weigert. In dividing the cord into different segments several areas in the lower dorsal segments were seen to contain small hemorrhages in the posterior horns on the right side and a similar condition in the left anterior horn. Otherwise nothing was noted macroscopiically.

Microscopically, the arteries and veins were

which split the horn in its long axis, pushing out laterally and externally a short distance. The lett anterior horn was also the seat of a well-defined hemorrhage, occupying almost the entire horn and breaking the tissue externally in places almost to the periphery (Fig. 3). Careful examination of the segments above and below this region failed to reve anything but distended vessels with here and there perivascular spaces filled with small amounts blood, involving also both crossed pyramidal tracts. more especially the right, from the fourth dorsa segment downward. There was very little glia c... infiltration, but it was apparently a chronic thick ening of the glia fibers. The changes in the ventral horn cells were eccentric displacement of the nucl and chromatolysis, varying in intensity on approach ing the lesion. These changes were confined to the cells in the left anterior horn, of the ninth des

FIG. 1. Section at the level of the eighth dorsal vertebra, showing the marked thickening of the media and adventitia with round cell increase. Zeiss, oc. No4, obj. DD.

everywhere throughout the cord and brain in process of arteriofibrosis. In the lower dorsal region especially, they were greatly distended with blood and thickened to several times their normal volume. The anatomical changes in the vessels, which consisted of an increase of connective tissue and loss of muscular fibers, were confined to the tunica media and propria, and in only a few instances did the tunica intima seem at all thickened (Fig. 1). In this region, also, we found many perivascular spaces filled with blood and distended vasa vasorum. The appearance of the vessels of the brain and medulla was strikingly different from that in the cord, for, in the former, the actual thickening was quite moderate and con

FIG. 3. Section at the level of the ninth dorsal vertebra, st two hemorrhages, one in the right posterior horn, the other anterior horn. Zeiss, oc. 2, obj. a. 2.

segment. The cells in the rest of the gray showed only an increase of pigment. We even in the left anterior horn, not far from the se of the lesion, apparently normal cells, while cr presented the well-defined chromatolytic chan that have been described.

The secondary degenerations (studied by Busch modification of the Marchi method) wer both ascending and descending type. Beginni the lesion and going upward, we found the dorsal segment the seat of the most diffuse chan The blackened granules occupied almost the e white matter externally to the horns, with exception of small margins at the periphery

FIG. 2. Section in the superior olivary region, showing the vessel moderately thickened as compared with those of the cord; also showing the enormous dilatation of the perivascular space. This is a fair type of the vessels of the medulla and brain. Zeiss, oc. No4, obj. DD. fined chiefly to the propria. The vessels were distended and their lumina were wide, and everywhere a most remarkable enlargement of the perivascular spaces was apparent, showing that there must have been great intravascular pressure (Fig. 2). One often finds the vessels, especially in the medulla, surrounded by a loose, connective tissue, apparently springing from the tunica propria. These spaces were not filled with blood, as in the lower dorsal region. The actual hemorrhage occurred in and was limited to the ninth dorsal segment. Here the right posterior horn was the seat of a well-defined hemorrhage,

FIG 4. Ninth dorsal.

externally to the basis of the posterior horns. were the seats of chronic sclerotic changes, and be show no degenerated myeline. The only spared were the posterior, two-thirds of the posterior column, and the median and poster of the left posterior column (Fig. 4). In the e dorsal segment the degeneration was begin be confined to Gower's column, with granules tered throughout the entire anterolateral g bundles, the anterior portion of the right p column, and a well-defined collection of g occupying the lower portion of Goll's colum right side. The left side showed only a few de erated fibers lying along the posterior median The involvement of the Gower's columns and

cerebellar tracts was still very diffuse on the left side. The seventh dorsal segment showed practically the same areas of involvement as the eighth. In the sixth dorsal segment the commissural portion of the left posterior column was involved more than the right. The posterior portion of the Goll's column still showed well-defined changes. The changes in the direct cerebellar tracts, Gower's columns, and the anterior portion of the left anterolateral ground bundles, were quite diffuse. In the fifth dorsal segment there were practically the same changes in the posterior columns, while the Gower's bundles and the direct cerebellar tract had become more and more differentiated. In the fourth and third dorsal segment there was practically no

bodies, the black granules were seen within and scattered over the greater part of the corpora restiforma.

In the tenth dorsal segment, below the lesion, were large degenerated areas, occupying almost the entire anterolateral ground bundles, with the exception of the commissural areas of the anterior tracts and the marginal surface of the right anterior tract. The degenerations in the posterior columns were confined to two small faintly deliminated comma-shaped areas internal to the posterior horns.

In the eleventh dorsal the degenerated areas were more confined to the lateral pyramidal tracts and the anterior pyramidal tracts, the left anterior tract being more involved than the right. There were, however, scattered bundles, although

FIG. 5. First dorsal.

hange. The second dorsal segment showed praccally the same condition, except that there was a ifference in the two sides, which consisted in the ranules on the left side being heavier, larger, and ore sharply defined than those on the right side. 1 the first dorsal segment (Fig. 5) the degenerated ea in the commissural portions of the posterior lumns consisted of only a few black granules. The ower's tract seemed to be more involved on the ght side than on the left. In the eighth cervical gment, the differentiation between the Gower's id the direct cerebellar tracts was well marked on th sides, but greater on the left than on the right. he seventh cervical showed practically the same anges. In the fifth cervical the degeneration in

FIG. 7. First lumbar.

not so many, throughout the entire anterolateral ground bundles. The degenerated areas in the posterior columns were much smaller and not nearly so well-defined as in the tenth.

The twelfth dorsal showed the degeneration well limited to the pyramidal tracts, while the degeneration in the posterior columns consisted of a few scattered black granules.

In the first lumbar segment (Fig. 7) the lateral pyramidal tracts were smaller, and the degeneration in the posterior columns appeared closer to the posterior median fissure. There was, however, well-defined degeneration in the peripheral portion of the anterior column on the left side.

In the third lumbar segment the degeneration had almost completely disappeared from the anterior columns, while it began to take on a definite

FIG. 6. Medulla; region of lower olivary bodies. !l's column did not extend to the commissural tion of the posterior tract, occupying only twords of the distance along the posterior fissure, and t proceeded upward this area became more and re limited to the extreme posterior portion of tract.

n the lowest portion of the medulla practically same changes existed as in the first cervical ment. Then, as we proceed upward, we find degenerated fibers occupying the nucleus cilis along the posterior fissure, in the region the inferior olivary bodies there are groups of ttered, blackened granules, confined to the terior margin, and a well-defined group of blackd granules near the substantia gelatinosa. Next, about the region of the middle of the olivary

FIG. 8. Second sacral.

form in the posterior columns, and consisted of a few fibers about midway between the commissura and the periphery, and a well-defined bundle lying near the periphery on either side of the posterior fissure. This, however, appeared like the triangular area of Gombault and Philippe.

The fifth lumbar and the sacral portions of the cord exhibited practically the same changes, except that the degeneration in the left lateral pyramidal tract was not so well defined as that in the right.

Examination of sections stained by the Weigert method showed practically the same changes, but also the extensive sclerosis involving the lateral

tracts.

The ascending degeneration followed principally the direct cerebellar and Gower's tracts up into the corpora restiforma. The variations in the degenerated area which we found in the different

segments were probably due to errors in technique, but the well-defined changes in the left anterolateral ground bundle could hardly be explained on that ground, and we think the ascending fibers in that bundle had been destroyed by the hemorrhage in the left anterior horn. The fact that the right column of Goll was so extensively involved and not the left, was due without doubt to the hemorrhage occupying the right posterior horn, although it must also, to a certain extent, have involved the column itself, or otherwise we should have found the area following a more radicular course. Instead of this, however, from that level up the degeneration was confined closely to a definite group of fibers into Goll's column.

Comparing the anterolateral and posterolateral tracts, we found that those of the left side in their entire course showed greater involvement than on the right, the explanation of which must lie in the fact that the hemorrhage in the left ventral horn occupied a considerable portion of the base of the posterior horn, and thus interfered with the fibers from which these tracts are derived. That both anterolateral halves showed symmetrical involvement at the level of the ninth dorsal segment, in no way disproved this assumption, since it was quite possible that while the myeline sheaths were destroyed, the axons of a considerable number of fibers might not have been permanently cut off, and hence the fiber resumed its natural appearance higher up, where it was relieved from the pressure of the extravasated blood. In connection with this we should like to remark, although it is perhaps quite unnecessary, that the idea of transmission of pain and temperature sense through these tracts seems unfounded, in view of the retention of both these senses in this case.

The descending degenerations in the posterior columns were too vague and ill-defined to throw much light on that subject; in fact, the findings were rather negative. It would appear, however, that this would support the contention for the exogenous origin of these tracts, since such an extensive lesion of the right posterior horn would give us the right to expect positive topographical evidences in these tracts, if they had their origin in post-horn cells.

Again, we cannot assume that the small portion corresponding to the triangular area of Gombault and Philippe supports the latter, since we had a well-defined degeneration in Goll's column at its dorsomedial margin.

Spinal arterial sclerosis is a condition that permits of being diagnosticated with considerable readiness, especially if there are symptoms, subjective or objective, pointing to generalized arterial sclerosis. As an example of this we may quote the following case:

Mr. W., a salesman forty-nine years old, came to the clinic complaining of general weakness and "nervousness," particularly in the legs. He says that if he walks a short distance he feels this weakness and so-called nervousness coming on in the legs. In addition, he has had for the past month or more a burning sensation in the epigastric region, which is unaffected by taking food. Latterly he has had a great deal of difficulty in holding the urine, a tendency to incontinence. The bowels are constipated. There has been no change in speech, and according to the patient, no mental deterioration except that he has had periods of melancholia. His eyesight has not been good since he was a child; the right eye being weaker than the left. Nine years ago this patient complained of similar symptoms, which came on after an attack of grippe.

He was treated in the clinic and recovered in about six months.

He is a fairly well-nourished man of medium build, rather pale and anæmic. His gait shows enfeeblement but no spasticity.

Examination shows a moderate sclerosis of the peripheral blood-vessels, the radials and temporals being distinctly palpable. Blood pressure with the Rivi Rocci apparatus, 185 (normal 135); pulse rate after sitting, 91. The strength of the lower extremities is perceptibly diminished. Although he is able to stand on either foot, his station is unsteady and he cannot maintain it long. Fe is unable to stand on the toe of either foot. The quadriceps extensor group is much weakened There is some diminution of the deep muscular sensibility. He interprets passive movements & his joints, but slight movements he finds difficult :: localize. This is also true of the position sense when he attempts to simulate the position of one leg with the other. There are no cutaneous sensory disturbances. The tendon jerks are all lively, but there is no Babinski phenomenon. Pupils norma and there is no facial rumor. The blood count shows nearly 5,000,000 erythrocytes and a relative normal number of leucocytes.

This patient, who is still under observation, has made great improvement while taking small doses of nitroglycerin and iodide, and availing himself c rest, warm baths, and massage.

There is scarcely any department of neurolog that stands more in need of reconstruction ther that which is now described under the name myeliti acute and chronic. When the term encephal is used, a well-defined clinical and pathologize. picture is suggested. On the other hand, undr myelitis are included, undoubtedly, many cases ( spinal arteriosclerosis, disseminated sclerosis, an obliterating endarteritis. We believe that the can and should be distinguished.

THE TREATMENT OF TUBERCULOSIS E
THE LARYNX AND OF THE PROSTAT
GLAND BY THE X-RAY, HIGH-FREQUEN
COOPER-HEWITT
CURRENTS, AND THE
LIGHT.*

DEMONSTRATION OF SPECIAL APPARATUS AND OF
RAPID METHOD OF SKIAGRAPHY.
BY SINCLAIR TOUSEY, A.M., M.D.,

NEW YORK.

SURGEON TO ST. BARTHOLOMEW'S CLINIC.

IN presenting the subject, the Treatment of Tuber culosis of the Larynx and Prostate by the X High-frequency Currents, and the Cooper-Hea Light, it may be best to first give a brief résumé the literature which has been found bearing upon I have not been able to find anything upon subject of this sort of treatment for tuberculosis the prostate gland.

In regard to the treatment of tuberculosis of t larynx by the x-ray, Williams, in his excellent w.. on "The Röntgen Rays in Medicine and Surge as aid to diagnosis and as a therapeutic agent, sa "The successful treatment of lupus by the should lead us to try them in laryngeal tuberculosis And Revillet, as long ago as 1897, reported a case acute pulmonary and laryngeal tuberculosis treat by the Röntgen rays. Both lungs and the larynx the patient were affected. The case was hopele before treatment was instituted, and the panc died. Some good effects, however, were no Sleep was improved, temperature became nor

*Read at a meeting of the Medical Association Greater City of New York, April 11, 1904.